探讨正常胰胆管汇合胰液胆管逆流与胆囊病变的关系

目的探讨正常胰胆管汇合(NPBJ)胰液胆管逆流(PBR)对胆囊的影响。方法 36例因胆囊疾病需要胆囊切除患者,术前ERCP或术中测胆汁测淀粉酶(BA)。胆囊标本行病理学及免疫组化(COX2,Ki-67,p53)检查。结果两组比较胆囊炎症、增生、化生及P53表达水平差异无统计学意义(P>0.05),而细胞异型、COX2和Ki-67表达水平差异有统计学意义(P<0.05)。结论 NPBJ者OPBR者,胆囊黏膜增生和化生性改变与胆囊结石所引起的病理改变无明显区别,但显示细胞异型和增殖活跃,OPBR可能是发生为胆囊癌的因素。

Correlation of Pancreatobiliary Reflux and Cholecystic Pathology in Patients with Normal Pancreatobiliary Junction

Objective To explore the correlation of pancreatobiliary reflux and cholecystic pathology in patients with normal pancreatobiliary junction.Methods 36 patients with gallbladder diseases were hospitalized for cholecystectomy.Bile was sampled during ERCP or cholecystectomy to detect amylase.Resected gallbladder specimens were examined histopathologically and then expression of COX2,Ki-67 and p53 were tested immunohistochemically.Results There was no significance both in frequency of inflammation,hyperplasia,metaplasia and in expression of p53 between the two groups(P>0.05),while higher presence of dysplasia and higher expression of COX2 and Ki-67 were seen in PBR group(P<0.05).Conclusion In patients with OPBR,although hyperplasia and metaplasia in gallbladder epithelium were similar to that induced by cholelithiasis,dysplasia and active proliferation more commonly occurred which might relate to the progress to malignancy.